SAN DIEGO – The introduction and dissemination of an antibiotic prescribing guide in a children’s hospital resulted in a statistically significant increase in appropriate prescribing, a prospective study showed.
“Antimicrobial drugs are one of the largest groups of medications prescribed to hospitalized children worldwide,” Dr. Jacqueline Wong wrote in an abstract presented at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. “Inappropriate antibiotic use is a major factor driving increasing bacterial antibiotic resistance. There are few published data on the effectiveness of stewardship strategies in a pediatric setting.”
Doug Brunk/Frontline Medical News
Dr. Jacqueline Wong
In a prospective observational study conducted during Dr. Wong’s pediatrics residency at British Columbia Children’s Hospital, Vancouver, she and her associates set out to compare the proportion of patients who received appropriate antimicrobials before and after the introduction of a new empiric antibiotic guide that was gradually rolled out at the hospital beginning in April of 2012 via lectures, paper copies, and pocket-sized and electronic versions. The time period studied was January 2012 to June 2013. All children admitted and treated with antibiotics were included in the analysis. Exclusion criteria included patients who were admitted to the neonatal unit or hematology/oncology ward, patients with cystic fibrosis, patients who were immunocompromised, and those receiving antibiotics solely for prophylaxis.
The researchers obtained prescribing information from hospital pharmacy data and electronic medical records, and two members of the study team used the updated empiric antibiotic guidelines to determine if the empiric prescribing was appropriate or not.
A total of 1,815 admissions were initially studied. Of these, 63% of the patients were younger than 3 months old, 16% were 4-6 months old, and 21% were 7-11 months old. These percentages did not vary significantly during the study time frame (P greater than .05). The five most common clinical syndromes were septicemia/meningitis (n = 556), respiratory tract infections (n = 532), intra-abdominal infections (n = 195), skin and soft tissue infections (n = 193), and urinary tract infections (n = 184).
Next, the researchers reviewed 752 admissions: 430 prior to introduction of the guidelines and 322 afterward. When they combined the five most common clinical syndromes, they observed a statistically significant increase in appropriate empiric antibiotic therapy between the preintervention period and postintervention period, from 65% to 74%, respectively (P = .035).
“What was interesting to learn from this study was the distribution of the various syndromes and distribution of the age groups of the children that were admitted,” Dr. Wong, now an infectious diseases fellow at The Hospital for Sick Children, Toronto, said in an interview. “The vast majority were 1 year and under.”
While the findings represent success in terms of patient care and cost savings, “the overall limited impact of such a passive antimicrobial stewardship program intervention suggests additional active strategies may be required to further enhance implementation, such as prospective audit with intervention, and feedback may be required to further enhance implementation of antimicrobial guidelines,” the researchers wrote in their abstract. For example, in response to the study findings, British Columbia Children’s Hospital implemented a formal multidisciplinary antimicrobial stewardship program including daily audit and feedback of all admitted patients on antimicrobials within 24 hours. “Data from this program are currently awaiting analysis,” they wrote.
The researchers reported having no financial disclosures.